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GIANT PHARMACY #363
DSH210015 FRANKLIN SQUARE HOSPITAL
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Covered Entity Details
Entity Name
FRANKLIN SQUARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210015
Entity Address
9000 FRANKLIN SQUARE DR
BALTIMORE, MD 21237
Medicare Provider Number
210015
Participating Start Date
4/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
GIANT PHARMACY #363
Pharmacy Address
1400 MERRITT BLVD.
DUNDALK, MD 21222
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deana Stout, VP FINANCE
(410) 554-2228
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
1/15/2025
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